Moral hazard and sickness insurance

We study if the replacement level in the Swedish national sickness insurance, which replaces foregone earnings due to temporary illnesses, affects work absence behavior. We use micro data and estimate the effects of a major reform, whereby the replacement level during the first 90 days in each absence spell was reduced, on work attendance. To separate out the effect of the reform from any trend in work absence, we distinguish between the implications on the incidence of work absence (i.e., the frequency of spells) and the duration of the spells. We also use a regression-discontinuity approach to estimate the effects on the prevalence of work absence. Finally, we estimate elasticities with respect to the replacement level in the sickness insurance.     

The impact of recall periods on reported morbidity and health seeking behavior

Between 2000 and 2002, we followed 1621 individuals in Delhi, India using a combination of weekly and monthly-recall health questionnaires. In 2008, we augmented these data with another 8 weeks of surveys during which households were experimentally allocated to surveys with different recall periods in the second half of the survey. We show that the length of the recall period had a large impact on reported morbidity, doctor visits; time spent sick; whether at least one day of work/school was lost due to sickness and; the reported use of self-medication. The effects are more pronounced among the poor than the rich. In one example, differential recall effects across income groups reverse the sign of the gradient between doctor visits and per-capita expenditures such that the poor use health care providers more than the rich in the weekly recall surveys but less in monthly recall surveys. We hypothesize that illnesses – especially among the poor – are no longer perceived as “extraordinary events” but have become part of “normal” life. We discuss the implications of these results for health survey methodology, and the economic interpretation of sickness in poor populations.     

Obesity and perceived work discrimination in Spain

Obesity is increasingly becoming a source of discrimination in many domains of living, including at the workplace. In this study, we estimate obesity-related discrimination in work settings in Spain and explore its potential sources. We use data from the European Health Interview Survey conducted in 2009–2010. Our models control for a comprehensive set of demographic, socioeconomic, health, and work-related sickness characteristics. We run separate models for women and men, and stratify by type of occupation and by area obesity prevalence. Our results indicate that weight-related discrimination in work settings in Spain is concentrated among women with morbid obesity, particularly among those working in customer-facing jobs and living in areas with low-obesity prevalence. These findings emphasize the persistence of the gendered nature of obesity-related discrimination, and provide evidence of a form of induced statistical discrimination. Employers’ expectations of lower returns from obese workers in customer facing jobs might be driven by customers’ preferences caused by social stigma. Furthermore, the role of area-obesity prevalence highlights the impact of cultural social norms even within the same country.     

Do the sick retire early? Chronic illness,asset accumulation and early retirement

Our objective is to determine how chronic illness affects asset accumulation and retirement. Previous studies have found that poor health leads to early retirement, but those studies failed to look at the indirect impact of chronic illness on retirement. Using data from the Health and Retirement Study, we define an illness as chronic if the individual reports having asthma, cancer, heart disease, stroke or diabetes for four or more years. We first estimate how a chronic illness influences asset accumulation. We then estimate how asset accumulation and current poor health influence retirement. We observe that the vast majority of the chronically ill population do not report their general health to be poor nor do they report functional limitations in activities of daily living. Nevertheless, our results indicate that chronic illness leads these people to accumulate fewer assets during their working years and consequently retire later. Neither researchers nor policy-makers discussing the many critical issues surrounding illness and retirement have addressed this issue.     

Investments in worker health and production: Evidence from Vietnam

In manufacturing industries, occupational health and safety measures ensure better working conditions for employees, which may influence their productivity. We study the impact of investments undertaken by small and medium enterprises in Vietnam in mitigating indoor pollution (including air quality improvements, heat and noise protection as well as lighting) on firm-level gross output and value added. We find that the amount invested by the firm in health has a significant positive effect on both outcomes. Given historically poor working conditions in Vietnam, policy implications relate to incentivizing and enabling firms to undertake such investments, on both moral and economic grounds.     

Healthier when retiring earlier? Evidence from France

This paper contributes to the literature on the health-retirement relationship by looking at the effect of retiring before legal age on health in later life in France. To account for the endogeneity of the early retirement decision, our identification strategy relies on eligibility rules to a long-career early retirement scheme introduced in France in 2004 that substantially increased the proportion of older workers leaving their last job before the legal age of 60 years. We find a positive correlation between early retirement and health problems among male retirees. However, we fail to find any significant causal effect of early retirement on poor health once we account for the endogeneity of the decision to retire before the legal age. Controlling for working conditions does not influence the effect of retirement and occupying a demanding job is harmful to health after retirement regardless of the retirement date. Similar results are found for female retirees.     

Do time limits in the sickness insurance system increase return to work?

This article analyzes the effect of stricter enforcement of the eligibility criteria in the Swedish sickness insurance (SI) system. In 2008, time-restricted assessments of the individual’s working capacity on the 91st and 181st sick day was introduced. Taking advantage of the quasi-experimental feature of the intervention, I find a large and significant increased exit rate around the 181-day assessment. The impact is the result of longer spells outside SI-benefits, indicating that the stricter rules create disincentives to report sick.     

Socio-economic evaluation of mental health as a basis for financing health care in Sweden

The objective of this paper is to examine hypotheses about the relationships between socio-economic factors, risk factors in working life, and the occurrence of mental illness, together with the degree of quality of life and consumption of health care, costs for health care, and costs for social insurance. This is a prospective and longitudinal study of 1,347 individuals of an active working age, 18–64 years, who have been on sick leave for more than 30 days. The group is characterized by the prevalence of risk factors in their work environment and welfare losses, such as multiple health problems, poor quality of life, inability to work, and dependency on society's support from health care and social insurance. The costs for health care were just over 2.8 million SEK, or 30 percent higher for those with psychological distress as compared to the group without. The payments from social insurance also increased by approximately 15 percent. The relatively greater weighting of health care costs and sickness cash benefits were motivating factors to study whether this group had an optimal amount and quality of health care, or if the resources available for health care should be distributed in another way that better satisfies the needs of the group.     

The medical doctors as gatekeepers in the sickness insurance?

Based on a randomized experiment, we estimate effects from notification to medical doctors of tighter monitoring of their Medical Certificates (MCs). Both the time prescribed by the doctor certificates for sick leave (prescribed sick leave) and the impact on the length of the actual sickness absence (actual sick leave) is studied. We find no effect on the total number of prescribed sick leave days. However, we do find an increase in both prescribed and actual sick leave with a 25% work inability. We also find that the notification letter causes an increase in actual sick leave (i.e. the number of reimbursed sick days). We discuss a number of potential explanations for this rather surprising result.     

Work-limiting health,earnings, and employment: an analysis with SIPP data

ABSTRACT

This study examines the role of work-limiting health conditions on employed people’s earnings, employment status, and working hours, and distinguishes between the different degree and severity of predictable shocks. Using data from the 2004 Survey of Income and Program Participation (SIPP), we evaluate the impact of any work-limiting health condition as well as a subset of health conditions that appear to arrive largely exogenously on post-onset earnings, employment, and working hours. We find that people who report being employed and later experience the onset of any work-limiting health condition tend to have lower subsequent earnings, a reduced probability of being employed, and fewer working hours per month compared to those who remain healthy. The adverse impact is even greater for people with health conditions that arrive less predictably. We use a difference-in-differences regression model with person and year fixed effects as the primary estimation method.     

Sickness Absence and Local Benefit Cultures

In many countries, sickness absence financed by generous insurance benefits is an important concern in the policy debate. There are strong variations in absence behavior among local geographical areas. Such variations are difficult to explain in terms of observable socioeconomic factors. In this paper, we investigate whether such variations are related to group effects in the form of social interaction among individuals within neighborhoods. Well‐known methodological problems arise when trying to answer this question. A special feature of our efforts to deal with these problems is that we adopt several alternative approaches to identify group effects. Our study is based on a rich set of Swedish panel data, and we find indications of group effects in each of our approaches.     

Working poverty,social exclusion and destitution: An empirical study

In economics destitution is traditionally interpreted as a product of labour market exclusion. Our work departs from the dominant models of poverty by considering destitution among a specific category of workers known as the working poor. Low wages and job insecurity in the informal sector in developing economies can create and perpetuate destitution among the working poor. Our precise contributions are three-fold: first, in order to understand causes and consequences of destitution, we develop an index of destitution from social exclusion of the working poor. Secondly, we test the predictions of this index by using micro-data collected from a sample survey in Bangladesh. Thirdly, from the micro-data we not only offer insights into the sources of destitution but also explain the factors that prevent the working poor from falling into the traps of destitution.     

Taxes,inequality and the size of the informal sector

In this note, we develop a simple heterogeneous-agent model with incomplete markets to explain the prevalence of a large, low-productivity, informal sector in developing countries. In our model, taxes levied on formal sector agents are used to finance the provision of a productive public infrastructure, which creates a productivity premium from formalization. Our model offers endogenous differentiation of rich and poor countries. Complete formalization is an equilibrium only in countries with the appropriate initial conditions. We discuss the existence of this equilibrium and highlight the ambiguous effect of taxes.     

How relative income affects work hours preferences

In this article, we look at explanations for why people want to change their working hours. We focus on the role of income and differentiate between the effect of household income, personal income and self-perceived relative income. Using Flemish data on 1435 workers, we perform binary logistic regressions in which we compare those who are over- or underemployed with those who are currently working their preferred number of hours. Our results show that the desire to work fewer hours is mostly related to a bad work–life balance, while the wish to increase working hours is associated with relative income rather than absolute income. Based on our findings we recommend governments to not only focus on increasing flexibility at the individual level but to also consider these positional effects by taking measures (e.g. decreasing the duration of the standard working week) at the population level.     

Human development and decentralization: The importance of public health expenditure

In this article, we empirically analyze the impact of central and subnational government spending on human development in a sample of 57 developed and developing countries over the period 2000–18. Specifically, we focus on the effects of health and education public expenditure on the Human Development Index (HDI) and its dimensions (life expectancy, education, and income). Applying data panel analysis, our empirical evidence shows the importance of central and subnational government health expenditure positively impacting on HDI and each of its components, while in the case of the education expenditure, this positive effect is only confirmed on the educational dimension of HDI. Our study shows how governments can stimulate human development, improving the well-being of citizens, by allocating more resources to healthcare through the different administrative levels.     

An Analysis of the Impact of Health on Occupation

Maintaining individuals with health limitations in the labour force is a challenge of growing importance. Determining the effect of health on occupation may tell us how people adapt to their limitations, and what types of jobs make this harder or easier. This paper uses the first 14 waves of the Household, Income and Labour Dynamics in Australia Survey to examine the effect of health and changes in health on occupation for the working‐age population. I use dynamic panel models which account for selection into employment. Two measures of occupation are used to capture two aspects of occupation highlighted in the literature as being linked to health: physical job demands and status. The results of the analyses provide some evidence that a health shock reduces the likelihood of manual employment for younger men, suggesting that younger men may adapt to a health shock by reducing physical job demands. Worsening health and work‐limiting long‐term conditions are found to have a negative effect on occupational status for men and women, suggesting health selection into lower‐status jobs, and an adverse effect of poor health on occupational mobility.     

The impact of scientific research on health care: Evidence from the OECD countries

This paper investigates the impact of scientific research on health care productivity in a set of OECD countries, in the years from 1960 to 2008. To this end, we have matched information collected from the OECD Health Data 2010 with data gathered from the Scopus database on the papers published and their relative citations. Our empirical results suggest that medical research plays an important role in explaining health care productivity, although various countries are characterized by different velocities in assimilating scientific knowledge. Another important result that emerges from our work is that countries characterized by a faster absorption of academic science, such as the US, have on average a milder impact of scientific research on health productivity, compared with countries with slower absorption. As one would expect, we also find that countries absorbing more scientific research also bear higher health costs.Results from this study may support policy makers in designing incentive mechanisms to improve the impact of medical research on the health care system.     

Are Underground Workers More Likely to be Underground Consumers?

We investigate the impact of working in the underground sector on the demand for underground commodities. Using a tax evasion model with costly information, we show that the presence of a network effect encourages underground workers to purchase underground commodities. The model is estimated using a unique Canadian microdata set for 1993. An increase in underground hours of work has a strong positive effect on the probability of purchasing underground commodities and on the level of expenditures. This relationship has a sizable effect on the impact of tax and enforcement parameters on the level of the underground economy.     

Changing the start of the hospital workweek

Essential to the success of a project of this magnitude were: (a) having the support and input of both management and staff; (b) clarifying federal wage and hour issues; (c) allowing adequate time for the change process; (d) determining impact of change on every hospital department; (e) providing hospital departments with necessary information, resources, and support to accommodate the change; and (f) communicating the change to each hospital employee in a timely manner. Can a hospital provide budget-neutral, flexible nurse schedules necessary to recruit and retain registered nurses? Yes, they can if they know how to do it. By redefining the workweek, Saint Marys realized an annual decrease of almost $750,000 in scheduled overtime expense for full-time nurses working 12-hour weekends, every third weekend. If health care institutions want the competitive edge in recruiting nurses, they will need to provide work schedules that are not only attractive, but also help ensure a positive "bottom line."